Cardiovascular outcomes at recommended blood pressure targets in middle-aged and elderly patients with type 2 diabetes mellitus compared to all middle-aged and elderly hypertensive study patients with high cardiovascular risk

• Published in: Blood pressure Vol. 30; no. 2; pp. 90 - 97
• Main Authors: Olsen, Eirik, Holzhauer, Björn, Julius, Stevo, Kjeldsen, Sverre E., Larstorp, Anne Cecilie K., Mancia, Giuseppe, Mehlum, Maria H., Mo, Rune, Rostrup, Morten, Søraas, Camilla L., Zappe, Dion, Weber, Michael A.
• Format: Journal Article
• Language: English; Norwegian
• Published: England Taylor & Francis 04.03.2021; Taylor & Francis Group
• Subjects: Antihypertensive treatment; blood pressure; blood pressure target; cardiovascular disease; cardiovascular risk; diabetes mellitus; hypertension; blood pressure; cardiovascular disease; blood pressure target; Antihypertensive treatment; diabetes mellitus; cardiovascular risk; hypertension
• ISSN: 0803-7051; 1651-1999
• DOI: 10.1080/08037051.2020.1856642

Event-based clinical outcome trials have shown limited evidence to support guidelines recommendations to lower blood pressure (BP) to <130/80 mmHg in middle-aged and elderly hypertensive patients with diabetes mellitus or with general high cardiovascular (CV) risk. We addressed this issue by post-hoc analysing the risk of CV events in patients who participated in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial and compared the hypertensive patients with type 2 diabetes mellitus with all high-risk hypertensive patients. Patients were divided into 4 groups according to the proportion of on-treatment visits before the occurrence of an event (<25% to ≥75%) in which BP was reduced to <140/90 or <130/80 mmHg. Patients with diabetes mellitus (n = 5250) were compared with the entire VALUE population with high CV risk (n = 15,245). After adjustments for baseline differences between groups, a reduction in the proportion of visits in which BP was reduced to <140/90 mmHg, but not to <130/80 mmHg, was accompanied by a progressive increase in the risk of CV morbidity and mortality as well as stroke, myocardial infarction and heart failure in both diabetes mellitus and in all high-risk patients. Target BP <130/80 mmHg reduced stroke risk in the main population but not in the diabetes mellitus patients. Patients with diabetes mellitus had higher event rates for the primary cardiac endpoint and all-cause mortality driven by a higher rate of heart failure. In the high-risk hypertensive patients of the VALUE trial achieving more frequently BP <140/90 mmHg, but not <130/80 mmHg, showed principally the same protective effect on overall and cause-specific cardiovascular outcomes in patients with diabetes mellitus and in the general high-risk hypertensive population.